Overtaxed UC Hospitals Turning Away AIDS Cases, Legislators Told

The University of California system, on which a third of the state’s AIDS patients depend for medical services, is reaching its capacity for AIDS care and has been forced in several cases to begin refusing new patients, officials testified Friday.

The outpatient AIDS clinic at UC San Francisco has been closed to new patients one-fourth of the time over the last year, officials said. The AIDS clinic at UC San Diego this month imposed its own limit and expects shortly to begin turning away patients.

‘Enormous Crisis’ Feared

“That closing of the doors will happen throughout the University of California system,” Assemblyman Tom Hayden (D-Santa Monica) warned Friday at a hearing on the university’s role in AIDS care. “Then we will have an enormous crisis that we will have to deal with.”

At the same time, university officials and physicians accused private hospitals and doctors of failing to share the burden of the AIDS epidemic--in part because growing numbers of AIDS patients are indigent and in part, they said, out of ignorance and prejudice.

In recent years, 90% of the Medi-Cal funding for AIDS care has gone to just 40 of the state’s 600 hospitals. Seventy-five percent went to just 15 hospitals--a group that includes the UC medical centers in Los Angeles, San Francisco, San Diego, Irvine and Sacramento.

“It is long past time to mainstream prevention and care efforts,” said Dr. W. Christopher Mathews, director of UC San Diego’s Owen Clinic. “We should abandon rhetoric which highlights our fear of being labeled as ‘AIDS hospitals’ or ‘AIDS providers.’ ”

Mathews and others drew a startling picture of how AIDS is swamping their institutions.

At the AIDS clinic at the UC San Francisco Medical Center, the number of patient visits jumped from 1,000 in 1985 to 4,200 in 1988. The patients coming into the clinic in recent months are both sicker than in the past and more likely to be indigent.

Dr. Ruth Greenblatt, a physician at the UC San Francisco clinic, testified that 31% of the patients were covered by the state’s Medi-Cal insurance program for the indigent in 1988. In the last three months, the percentage leaped to 47%, according to a recent study.

Clinic Visits Quadruple

A similar pattern is evident at UC San Diego where the number of monthly clinic visits quadrupled in the last two years. Mathews said 35% of the patients at the Owen Clinic are covered by Medi-Cal and 20% by the county’s program for the indigent. Only 15% have private insurance.

Meanwhile, the Medi-Cal reimbursement rate is dropping: The percentage of hospital charges covered by Medi-Cal dropped from 66% in 1984-85 to 56.3% in 1987-88, according to Bob Heilig of the California Assn. of Hospitals and Health Systems.

“The Medi-Cal program pays far less than the minimum cost for necessary medical care,” Dr. Gerard Burrow, UC San Diego vice chancellor for health affairs, told members of the Assembly subcommittee on higher education. “Neither the university nor other health-care providers can hope to solve this problem without a major shift in present reimbursement policies.”

Physicians and administrators also called for educational programs in AIDS care for private physicians trained in an era before AIDS. One private hospital chief of staff called for a state law mandating AIDS training for all physicians.

But at least one physician was pessimistic.

Dr. Brett Cassens, an AIDS specialist at UC San Diego and in private practice, said there are numerous disincentives to treating AIDS: The disease is complicated, treatment changes rapidly and even physicians themselves risk being stigmatized as AIDS doctors.

Cassens said he could see neither a short-term nor an easy long-term solution to the problem plaguing the UC medical centers, adding, “And I don’t believe it lies in the private community.”